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D2 - Perio > 3 - Tx Prognosis > Flashcards

3 - Tx Prognosis Flashcards

1
Q

Except for emergencies, no dental treatment should be initiated until when?

A

A treatment plan has been established and accepted by the patient

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2
Q

When can a treatment and sequence of treatment be planned?

A

After a diagnosis and prognosis have been determined.

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3
Q

What is the Urgent Phase?

A
  • It begins with a thorough review of the pt’s medical condition and history. This initial emergency appointment is to establish pt’s comfort and may include:
    • Eliminate pain and or abscess
    • Address emergency concern
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4
Q

What is the Control Phase?

A
  • Control active pathological lesions
  • Control general caries
  • Control plaque and initial perio therapy
  • Initiation of endo treatment
  • Provisional restoration for esthetic and or functional reason
  • Establish required VDO
  • Initiation of ortho stabilization
  • Initial tooth prep and provisional for diagnosis purposes
  • Oral surgery procedures
  • Establishing design for fixed/removable pros
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5
Q

What phase of treatment is to determine the response to our initial therapy before our definitive phase begins?

A

Re-Evaluation Phase

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6
Q

What’s the Definitive Phase?

A
  • After re-assessing initial treatment, includes all therapies that restore function after pt’s disease has been controlled
    • Fixed/removable pros
    • Implant restoration
    • Ortho
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7
Q

What’s the initial therapy for Gingivitis?

A
  • Medical consult (if indicated)
  • OHI
  • Full-mouth scale and polish
  • Re-eval 4-6 weeks
  • Prophy every 6 months if resolved
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8
Q

What is the initial therapy for mild chronic periodontitis?

A
  • Medical consult (if indicated)
  • OHI
  • Quadrant or half mouth SRP w/ anesthesia
  • 2-4 appts
  • Re-eval 4-6 weeks
  • 3-4 month maintenance
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9
Q

What’s the initial therapy for moderate chronic periodontitis?

A
  • Medical consult (if indicated)
  • OHI
  • Quadrant SRP w/ anesthesia
  • 2-4 appts, re-eval 4-6 weeks
  • Local antimicrobials in 5-6 mm pockets
  • Refer to periodontist
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10
Q

What is the initial therapy for advanced chronic periodontitis?

A
  • Medical consult (if indicated)
  • OHI
  • Quadrant SRP w/ anesthesia
  • 2-4 appts, 4-6 Re-eval
  • Local antimicrobials in 5-6 pockets
  • Refer to periodontist
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11
Q

What is the sequence of thoughts when determining prognosis?

A
  • Diagnostic prognosis
  • Therapeutic prognosis
  • Prosthetic prognosis
  • Provisional prognosis
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12
Q

How is prognosis divided?

A

Into:

  • Overall prognosis
  • Individual tooth
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13
Q

What is the single most important risk factor for overall prognosis/systemic background?

A

SMOKING

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14
Q

Cigarette smokers are _____ times more likely than non-smokers to develop severe periodontitis?

A

5-8 times

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15
Q

What are the negatives for smoking relating to periodontitis?

A
  • Inhibits wound healing, following therapy
  • Alters quality of microbiota in pockets
  • Decreases nuetrophils, chemotaxis, phagocytosis and oxidative bursts
  • Increases collagenase production
  • Decreases GCF flow
  • Vaso-constrictor
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16
Q

What are the positive benefits related to smoking cessation at 20 min?

A
  • BP drops to normal
  • Pulse rate drops to normal
  • Peripheral body temp increases to normal
17
Q

What are the positive benefits related to smoking cessation at 8 hours?

A
  • CO in blood drops to normal
18
Q

What are the positive benefits related to smoking cessation at 24 hours?

A
  • Chance of heart attack decreases
19
Q

What are the positive benefits related to smoking cessation at 2 weeks - 3 months?

A
  • Circulation improves
  • Lung function increases up to 30%
20
Q

What are the positive benefits related to smoking cessation at 1 -9 months?

A
  • Coughing, sinus congestion, shortness of breath decreases
  • Cilia re-grow in lungs thereby enhancing host defense against respiratory infections
21
Q

What are the positive benefits related to smoking cessation at 1 year?

A
  • Risk of coronary heart disease is 50% less
22
Q

What are the positive benefits related to smoking cessation at 5 years?

A
  • Lung cancer death rate for avg smoker decreases by almost 50%
  • Stroke risk is reduced to that of non-smoker in 5-15 year quit range
  • Risk of oral, pharynx and esophageal cancer is 50% less than that of a smoker’s
23
Q

What are the positive benefits related to smoking cessation at 10-15 years?

A
  • Lung cancer death similar to non-smoker
  • Risk coronary heart disease is that of non smokers
24
Q

What effects does diabetes have on patients concerning perio?

A
  • Altered oral microbial flora
  • Altered host defence mechanism
  • Vascular changes
    • Increased thickness of basement membrane and vessel wall
  • Collagen breakdown
25
Q

What microbes are more commonly seen in patients with:

Diabetes type 1?

Diabetes type 2?

A
  • Type 1 - Captocytophaga sp
  • Type 2 - Porphyromonas gingivalis
26
Q

Compare Untreated, Treated with no maintenance and Treated with regular maintenance to avg teeth lost per year?

A
  • Untreated - 0.36 teeth/yr
  • Treated w/ no Maintenance - 0.22 teeth/yr
  • Treated w/ Maintenance - 0.11 teeth/yr
27
Q

The level of oral hygiene at the 1st treatment appointment is not as important as the level of oral hygiene at the completion of the initial phase of treatment (phase 1) - True or False?

A

True

28
Q

Which has the WORSE prognosis:

  1. Aggressive “juvenile” Perio vs Chronic “adult” Perio
  2. Present inflammation vs non-present despite disease severity
  3. Abudant plaque vs almost absent
  4. Chronic infection bone loss vs periodontal abscess bone loss
A
  1. Aggressive “juvenile”
  2. Non-present inflammation
  3. Almost absent plaque
  4. Chronic infection
29
Q

For SRP at a PD > 5mm, residual calculus will remain how often?

A

85% of the time

30
Q

How deep is the curette effecient at? And what’s the instrumentation limit?

A
  • Curette efficiency: 3.73 mm
  • Instrumentation: 5.52 mm
31
Q
  1. Probing depths are less important than _______?
  2. PD > 6mm will be difficult to maintain without surgery but, prognosis should be based on ____ not by _____?
A
  1. Attachment loss/bone loss
  2. CAL not by PD
32
Q

What is the average loss of teeth with furcation involvement following treatment?

A
  • % lost - 35.7%
  • Years - 20.5
33
Q

Classify prognosis based on furcation involvement.

A
  • Class I - Fair
  • Class II - Questionable
  • Class III/IV - Poor/Hopeless
34
Q

Which furcations have the best predictability for regenerative procedures?

A
  • Buccal maxillary furcations
  • Mandibular furcations
35
Q

Classify prognosis based on tooth mobility.

A
  • Class 1 - fair (slightly mobile)
  • Class 2 - questionable (moderate more than normal)
  • Class 3 - hopeless (severe mobility + depressive)
36
Q

What are the reasons for mobility beyond physiologic range?

A
  • Loss of support
  • Inflammation
  • Trauma
37
Q

It is extremely difficult to predict the prognosis of a tooth if the initial prognosis is other than _____?

A

Good

38
Q

What are the key questions a patient will ask?

A
  • Cost?
  • Will it hurt?
  • How long will it take?
  • How long will it last?
  • How will it look?
  • What if I don’t do anything?
  • What are the alternatives?

D2 - Perio (5 decks)

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